Healthcare Provider Details

I. General information

NPI: 1528632692
Provider Name (Legal Business Name): GAMZE KIRCALIOGLU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17095 MAIN ST STE 100
HESPERIA CA
92345-6004
US

IV. Provider business mailing address

PO BOX 41077
LOS ANGELES CA
90041-0077
US

V. Phone/Fax

Practice location:
  • Phone: 760-241-6666
  • Fax:
Mailing address:
  • Phone: 323-316-4076
  • Fax: 213-617-1320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95026036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: